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NEWS IN CONTEXT

World AIDS Day 2008—Still Time to Get PEPFAR Right

November 21, 2008

As the global community marks World AIDS Day on December 1, advocates and policy experts welcome the promise by the incoming Obama administration to put sound scientific evidence at the forefront of the U.S. global AIDS program (PEPFAR). President-elect Obama’s campaign Web site states that the “first priority is…to ensure that best practices—not ideology—… drive funding for HIV/AIDS programs.” And indeed, both the new administration and the incoming Congress will have opportunities next year to do just that.

In August 2008, the U.S. government reauthorized the PEPFAR program, committing $39 billion over five years to the global fight against HIV. The new PEPFAR law features many improvements over the law that guided the program’s first five years; however, it, too, falls short in terms of HIV prevention policy.

What PEPFAR will actually look like on the ground later next year will depend largely on the new administration. In 2009, the incoming administration will develop a plan to implement the reauthorized PEPFAR that could remedy or at least mitigate some of the law’s shortcomings. It will make a host of crucial decisions, from how best to prevent the sexual transmission of HIV to how to better integrate HIV prevention and reproductive health services.

Backed by a growing body of evidence, policies at the global level already recognize the importance of linkages between HIV and reproductive health services. But the United States remains a major obstacle to effective integration, and the PEPFAR law is silent on the importance of linkages. That the U.S. government has failed to join and actively support the global integration consensus is exacerbated by the erosion of U.S. support for international family planning programs.

The issue of better integrating HIV and reproductive health services is especially important in countries with high rates of HIV infection, which often are impoverished and have poor health infrastructures. It makes eminent sense to offer women the services they need—whether related to HIV or to reproductive health—in settings they already frequent. For instance, PEPFAR should pay for HIV testing, counseling and referral at sites that women already visit regularly to obtain family planning services. In turn, women should be able to obtain contraceptives to avert pregnancies they themselves don’t want at sites they already visit to receive HIV services.

Embracing proven interventions that promote HIV–reproductive health service linkages, along with promoting needed increases in international family planning assistance, would allow the United States to begin reclaiming its role as a leader in international sexual and reproductive health.